DESCRIPTION: Musculoskeletal disorders (MSDs) affect over 40 million Americans and are the leading cause of activity limitations. Health care costs for arthritis and osteoporosis alone exceed $75 billion per year. In the past decade, there has been a dramatic rise in the number of new therapies for MSDs. During its short tenure, the Alabama Musculoskeletal Disorders CERTs (AMSDC) at the University of Alabama at Birmingham (UAB) has successfully identified, funded and conducted a large number of projects investigating and disseminating knowledge about safe and effective use of MSD therapeutics. Emphasizing the importance of the AMSDC network for promoting multi-disciplinary and public-private programs, the applicant has developed active collaborations with three of the other CERTs, with FDA/CBER and NIAMS, the VAHSR&D, national managed care organizations (Aetna & UHC), CMS' Quality Improvement Organizations (QIOs), the Alabama Department of Public Health and several pharmaceutical manufacturers. These collaborations are indicative of the AMSDC's ability to leverage AHRQ core support to build a productive, diverse, and sustainable center. The application's main objective is to seize the momentum of current successes and continue to expand knowledge regarding MSD therapeutics. The specific aims of the AMSDC renewal are as follow: 1. Improve safety and effectiveness of musculoskeletal therapeutics through: a. A randomized trial of a combined physician/patient intervention to improve the safety of NSAID uses in the ambulatory setting (Module 1); b. A pharmacoepidemiological study followed by a randomized trial of a direct to patient intervention to improve safety in gout treatment (Supplemental Module 2); c. The support of nine demonstration projects focusing on diverse areas within MSD therapeutics, all bound by the common thread of improving safety and effectiveness, with the goal of submitting applications for funding to outside agencies; 2. Expand existing collaborations in both the private and public healthcare sectors; 3. Educate practitioners, insurers, policy makers, and the general public about musculoskeletal therapeutics. Given the rising burden of MSD in an aging society and the rapidly advancing efficacious, yet costly and potential dangerous, therapeutic options the objective and aims of the AMSDC are both well timed and urgently needed to improve public health.